It is a MOOD disorder where you have extremes of mood swings. You may feel extremely low or “depressed” or extremely high or “manic”, or mixture of both. Whatever the mood is, it is far beyond the emotional ups and downs that a person normally experiences. An episode usually lasts for weeks to months.

In Bangladesh, about 0.4% of the adults and 0.1% of children below 18 years are suffering from bipolar disorder. It is not a common but a major psychiatric disorder and prevalence is higher in the cities than in the rural areas.

In bipolar disorder, there are two extremes or poles of mood, with normal or near normal mood in between the episodes. These are known as mood or “affective” symptoms.

You feel extremely low and unenergetic. Every little task, even getting up from bed takes a toll on you. Nothing seems to cheer you up; nothing makes you happy. You feel like crying all the time and you don’t even know why. You can’t concentrate on your work, you feel worthless, your existence feels meaningless and sometimes, you feel you would rather die. You can’t sleep and even when you do, you wake up early. You lose your appetite to eat. Each depressive episode may last up to 6 months to even 1 year.

The extreme opposite happens in mania. You feel so happy and cheerful, feel so energetic that you don’t need to sleep or eat, and work all day. Your family and friends see an unusual change in your behavior. You start making big plans for the future, spending money extravagantly, buy and wear new clothes that you normally wouldn’t have. To an extent, the optimistic attitude is acceptable, but then you lose control of your thoughts and behavior. Each manic episode does not last for more than 6 months, usually.

• Bipolar I Disorder: If you have at least 1 manic episode in your lifetime which lasted for at least a week or you were hospitalized, you will be diagnosed as a case of bipolar I disorder. You may have several manic episodes, with periods of depression.


• Bipolar II Disorder: You have at least one episode of severe depression and at least one episode of mild manic symptoms, called “hypomania”.


• Rapid Cycling Disorder: You have repeated episodes of mania, hypomania or depression (at least FOUR or more) in 1 year.
  
  In between the episodes of bipolar disorder, you may feel completely normal, but some do not.

Medications

Treatment with mood stabilizers is usually started by psychiatrists after they assess your physical and mental conditions. Lithium and sodium valproate have been used for treating bipolar patients for generations now. Antipsychotics and antidepressants are may also be added depending on the severity of the mood symptoms.

Learn to recognize your mood swings. You can keep a mood diary to record them.

Decreased sleep, altered sleep cycle are also early signs and should not be ignored.

Stressful situations that can make you more emotionally vulnerable and trigger an episode. Sometimes it is not possible to avoid these situations, so Therapy can help you better to cope with stressful situations.

Use of illicit or recreational drugs.

Try to balance your life with work and leisure activities.

Make sure you regularly do something you enjoy.

Eat healthy and stay physically active.

• National Institute of Mental Health and Hospital, Dhaka
• Department of Psychiatry, BSMMU, Dhaka
• Any nearby Government or Private Medical College & Hospitals with PsychiatryDepartments

Dementia is a general term used to describe a group of conditions which affect memory. There are many types of dementia,most common being Alzheimer’s disease, vascular dementia and dementia with Lewy bodies.

About two in every 100 people at around age of 65 develops dementia. The rate increases to 8-10% for people over 80. Dementia is different from normal ageing related memory loss and is not only about memory loss. It can also affect the way someone speaks, thinks, feels and behaves.

Depending on the type and severity of dementia, symptoms vary. Some common symptoms are –

• Difficulty in learning new things
• Finding it hard to remember the names of people, places, recent events, appointments, phone messages, etc.
• Difficulty in remembering where they have put things
• Difficulty concentrating, struggling to follow a conversation or finding the right word
• Mood swings or depression
• Physical problems such as difficulty in walking, or incontinence

A doctor will first conduct an interview to test the cognitive functions like memory, attention, orientation, language, etc. Then he will conduct some physical examinations. The interview and physical examination will give him clues about the possible type of dementia. Then to confirm diagnosis he may recommend some blood tests and CT/MRI scan.

Anyone can develop a dementia but it is not a natural or inevitableconsequence of ageing. Some medical conditions like Parkinson’s disease, stroke, high blood pressure, high cholesterol level can make it more likely. Lifestyle factors like smoking, alcohol use, lack of physical exercise, obesity can increase risk of some types of dementia. Finally, genes play a part in some types of dementia.

This will depend upon the diagnosis and presentation of the person. A group of drugs called anti-dementia drugs (donepezil, galantamine, rivastigmine, memantine) can treat some of the symptoms of dementia and delay progression of the disease. Doctor might prescribe him drugs to control high blood pressure, diabetes and raised cholesterol level. Vitamin B and E, fatty acid (including fish oils) and complex dietary supplements have no proven efficacy in dementia. Non-pharmacological interventions like cognitive stimulation, sensory stimulation, behavioral management may help to improve quality of a person’s life.

Depression and anxiety are common in people with a dementia. Depending on the condition, depression and anxiety can be treated with antidepressants and psychotherapy.

• Person with dementia can use a diary to remember appointments.
• Can make lists of things that need to be done and tick them off as it is completed.
• Keep mind active by reading or doing puzzles, learning new things.
• Eat a healthy diet and take physical exercise.

Psychiatrists and neurologists are the specialized doctors who treat dementia. You can get help and support at the Psychiatry and Neurology Departments of all medical college hospitals. In addition, many districts level hospitals have consultant psychiatrists and neurologists to help you.

Depression is the most common mental illness in Bangladeshi adults. It negatively affects how someone feels, thinks and acts. Depression causes feeling of sadness and loss of internet in activities someone once enjoyed. It can lead to variety of problems that can decrease the ability to function properly at work and home.

Depression affects an estimated one in 15 adults in Bangladesh in any given year. One in 6 people will experience depression at some time in their life.

Depression is different from sadness or grief. Loss of a job, relationship breakdown, death of a loved one are stressful experiences and it is normal to feel sadness in such situations. But being sad isn’t the same as depression.

Depression symptoms can vary from mild to severe and usually lasts for several weeks. The usual symptoms are

• Feeling sad or having a depressed mood
• Loss of interest or pleasure in activities once enjoyed
• Changes in appetite — weight loss or gain unrelated to dieting
• Trouble sleeping or sleeping too much
• Loss of energy or increased fatigue
• Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)
• Feeling worthless or guilty
• Difficulty thinking, concentrating or making decisions
• Thoughts of death or suicide

In addition, some people may have headache, bodily pain, palpitation, sexual problem, menstrual irregularity, constipation while experiencing a depressive episode.

• Exposure to physical, emotional, sexual abuse, neglect, poverty makes people vulnerable to depression.
• People will low self-esteem, inability to cope with demands of life, anxiety prone personality and pessimistic people are more likely to experience depression.
• Sometimes depression is mediated by genetic factors and runs in family.
• Major life changes, trauma, stress, smoking, drug abuse.
• Women are more likely than men to experience depression.
• Some physical conditions and medications can cause depression.

• Take regular exercise, it helps to create positive feeling and improves mood.
• Maintaining a healthy lifestyle, eating a healthy diet, exposure to sunlight, getting enough sleep can also help to reduce symptoms of depression.
• Try to spend time with other people, try not to isolate yourself.
• Set realistic goal for yourself.
• Educate yourself about depression. There is strong evidence that for mild to moderate depression reading self-help books can improve your wellbeing. We have recommended some books in our book review portion of the website.

Depression is among the most treatable of mental illnesses and 80-90% of people with depression start to feel well within two weeks of starting the treatment.

For people with moderate to severe depressions psychiatrists usually recommend a class of medicine known as anti-depressants. If you have sleep problem, a psychiatrist may prescribe you an anti-depressant with additional sedative effect. But there are many anti-depressants which will not make you sleepy. Discuss with your doctor to find what suits you best. These medicines are not addictive and you can stop anytime. But, discuss with your doctor before stopping anti-depressant medicines, because sudden stoppage may cause withdrawal symptoms or your depression may relapse.

Psychiatrists usually recommend that patients continue to take medication for six or more months after the symptoms have improved. Longer-term maintenance treatment may be suggested to decrease the risk of future episodes for certain people at high risk.

For mild depression, psychotherapy is usually recommended. Psychotherapist may teach you skills to monitor and challenge your negative thoughts, cope with difficulties, improve interpersonal relationships, etc.

Psychiatrists are the doctors who treat depression. You can get help and support at the Psychiatry Departments of all medical college hospitals. In addition, many districts level hospitals have consultant psychiatrists to help you.

In this advancing world, Bangladesh following the western trends, smoking, drinking and doing recreational drugs has become a common part of the youth culture. You start it as just for having fun or experimenting, and before you know it, you are addicted to it.

Nearly half of the people in our country start taking some sort of drugs from a very young age.

• 3% of children from 7 years of age have smoked or chewed tobacco (cigarettes, gul, tamak pata) at least once in their life.
• 2% of children between 7-12 years have tried recreational drugs.
• 8% of adolescents between 12-18 years.
• 3% of the youth start using drugs by 18 years of age.
• 9% between 18-27 years use drugs.

Even though the risk is higher among the youth population, the abuse is also seen among day laborers (6.7%), unemployed (5.7%), business men (4.3%), farmers (3.8%) and service holders (3.5%).

• Cannabis (Ganja, weed, hash, brownie)- 42.9%
• Alcohol- 27.5%
• Amphetamine (Yaba, ice, speed)- 15.2%
• Opioid (Heroin, phensidyl)- 5.3%
• Sedatives- 3.8%

When you are using it occasionally or for recreation only, it will create no problem in your regular work or activity. In fact, it can be hardly detected.

When a person starts using it on a regular basis, their behavior starts changing.

• Loss of interest in school or work, poor academic and job performance.
• Unusual sleeping patterns like sleeping at daytime and staying awake at night.
• Unusual smells and items like foil paper, needle covers, etc.
• Demanding money, unusual need for money or unexplained loss of money or expensive belongings or expensive items missing from home.
• Behavior that is “out of character” like moodiness, going outside frequently at the same hours, change of daily routine.
• Shifts in social circles, making a new set of friends with whom they do drugs and go to different places to use the drugs.
• Repeated lying, dishonesty and deceit, legal issues.

• Change your social circle with who you started using them.
• Start focusing on your hobbies and spend more time on them.
• Eat healthy and do physical activities.
• Share with a family member, sibling, relative or a friend you can trust.
• Ask for help from a psychiatrist and counsellor.



REMEMBER THAT DETERMINATION IS YOUR STRENGTH.

BELIEVE YOU CAN, AND YOU ARE HALFWAY THERE.

When you suspect your child is taking drugs, make sure you get your facts right.

• Pay attention to what your child is doing, school performance, friends, leisure activities.
• Research on the internet about effects and signs of drug abuse.
• Talk to your child about his or her point of view about drugs, if he or she is going through a rough patch in life.
• Do not blame your child or get angry. Encourage them to be responsible and support them in this journey.

When you know you have no control over the drug use, you cannot concentrate on anything and spend a long time using or making arrangements for getting the drugs, your social life, work life, family life all are being affected, YOU NEED HELP. Here are some places you can seek help.

• National Institute of Mental Health and Hospital, Dhaka
• Central Drug Addiction Treatment Centre, Tejgaon, Dhaka
• Department of Psychiatry, BSMMU, Dhaka
• Psychiatry Departments of all medical college hospitals.
• District level hospitals (also known as Zila Sadar Hospitals) where Psychiatry consultancy is available.

Obsessive-compulsive disorder (OCD) is a common mental health condition where a person has reoccurring(obsessive) thoughts and/orbehaviors (compulsion) that he/she feels the urge to repeat over and over again.

About 2-3 people in every 100 people suffer from OCD at some point in their lives. It affects men and women equally. Adult OCD usually begins in the teens or early twenties. OCD is usually a chronic and long-lasting disease and symptoms tend to wax and wane over time.

People with OCD have symptoms of obsessions, compulsions or both. Obsessions are repeated unwanted and unpleasant thoughts, urges, or mental images that cause anxiety, disgust or unease. Compulsionsare repetitive behaviors or mental acts that a person with OCD feelsthe urge to do to temporarily relieve the unpleasant feelings brought on by the obsessive thought. Obsessions can take several forms –

• Thoughts: Single word, short phrase or rhymes that are unpleasant, shocking or blasphemous.
• Pictures in mind: Disturbing pictures like doing something violent or sexual which is completely out of character.
• Doubt: Repeated doubt enters into the mind, like you may wonder whether you have left your doors and windows open.
• Ruminations: Endless argument with oneself about whether to do one thing or another so even the simplest decision is hard to reach.
• Perfectionism: Excessive concern about right way of doing things, maintaining right order, right place, balance.

Compulsion can take the forms of –

• Rituals: Like washing hands frequently, doing things slowly, arranging objects in a particular way.
• Repeated checking: Like whether house is locked, weather is good, journey route is safe,dirt in the body.
• Avoidance: Like avoid touching particular objects, going to certain places.
• Hoarding: Keeping useless and worn-out possessions.
• Reassurance: Repeated need to tell that everything is fine.

The exact reason is difficult to pinpoint. But there is evidence that a brain chemical called serotonin may work in a different way in the brain of a person with OCD. Sometimes OCD is inherited, other times stressful life events and life changes like puberty, birth of a child can precipitate an OCD episode. Some people who are neat, meticulous, methodical with high standards may be more likely to develop OCD.

OCD is treated by certain medications and psychotherapy, often by combining both. SSRI group of medications can help to reduce obsessions and compulsions. Remember, they are known as anti-depressants, but also work in OCD. It isbest to continue medication for at least 12 months, if it is helping. Thesemedications are not addictive, but should be cut down slowly over severalweeks before stopping.

Psychotherapies like guided self-help, cognitive behavior therapy, exposure and response prevention therapy can also help someone suffering from OCD.

• Remember OCD obsessions and compulsions are not your fault and you are not going mad.
• Expose yourself to your troubling thoughts. This sounds odd, but it’s a wayof getting more control of them. You can record them and listen back tothem, or write them down and re-read them. You should do this regularlyfor around half an hour everyday until your anxiety reduces.
• Resist the compulsive behavior, but not the obsessional thought.
• Stop fighting your thoughts. Do not try to push unpleasant thoughts out of your mind – this usually onlymakes the thoughts return. Unpleasant thoughts happen, you learn not to resist them, to just let them happen, andto think about them in the same way.Such thoughts will often fade away when you stop trying to make them go away.
• Rituals, checking, avoiding and seeking reassurance will all make you less anxious for a short time – especially if you feel that this might prevent something dreadful from happening. But, every time you do them, you strengthen your belief thatthey stop bad things from happening. And so,you feel more pressure to do them… and so on.
• Do not place too much importance on your thoughts, they are just thoughts. Do not overestimate the chance of bad happening.
• Challenge your thought by asking yourself – what is the evidence for and against this idea? How useful is this thought? What is another way to look at this? What is the worst and what is the most realistic outcome? How would you advise a friend who had similar problem?

It may be helpful for you to seek further support if you can’t stop the obsessions and compulsionsby yourself and a psychiatrist may be the best person to talk to first. They may prescribe some medicines or may recommend psychotherapy for you or both. You can get help and support at the Psychiatry Departments of all medical college hospitals. In addition, many districts level hospitals have consultant psychiatrists to help you.

If you’re planning a pregnancy and have a mental health condition, or taking medicine for a mental health condition, or have had one in the past, it’s a good idea to discuss your plans with your doctor (or psychiatrist if you have one) as part of yourpre-pregnancy counselling.This is particularly important if you havehadconditions like bipolar disorder, schizophrenia, postpartum psychosis, depression, obsessive-compulsive disorder.

Physical as well as mental health is important to have a healthy pregnancy. You will have a healthier pregnancy if you do these things –

• Lose weight if you are overweight – healthy eating and exercise may help.
• Increase your weight if you are underweight
• Take folic acid (400mcg daily) for 3 months before you get pregnant and for the first 12 weeks of pregnancy. This can reduce chance of your baby having birth defects.
• Take higher dose of folic acid (5mg daily) if you are on some medications, e.g., carbamazepine.
• Take a vitamin D supplement.
• Make sure your vaccinations are up to date.
• Get advice about any physical health problem.

• You need to think carefully about the risks and benefits of psychiatric medication are for you and your baby. It may be safer to take medication in pregnancy than to stop if you have had a more severe illness. If you want to get pregnant, discuss your medication with your doctor/psychiatrist. Don’t stop medication or reduce the dose suddenly against their advice specially if you have severe mental illness, as you are more likely to become unwell again.
• Some drugs like sodium valproate, carbamazepine have higher chances of causing birth defects and a doctor may suggest you safer alternatives of these drugs before you start planning for pregnancy.
• It is wise to use contraception until your doctor see it is safe for you to plan pregnancy.
• Many pregnancies are unplanned. If you are on medication, try to see your doctor as soon as possible.

The decision to continue or stop medication depends on many factors like –

• How unwell you have been in the past.
• How quickly you become unwell when you stop medication.
• Which treatment have helped you most?
• Have some medications caused side-effects?
• Are the drugs you taking safe in pregnancy?

You also need to consider what might happen if you are unwell during pregnancy –

• You may avoid food and you and your unborn baby’s nutrition may suffer.
• You may not be able to take good care of yourself and your unborn baby.
• You may need higher dose of medication or need two or more medications to treat a relapse. This might be riskier for you and your unborn baby than if you take standard dose of medication throughout pregnancy.
• You may need hospital admission.
• Untreated mental illness may cause a number of problems. For example, babies are more likely to have low birth weight if their mother has depression in pregnancy.
• You need to keep in mind that, 2-3 in every 100 babies are born with a birth defect even when the mother has not taken any medication.

Breastfeeding is usually good for mother and baby. Many of the psychiatric medication are safe for lactating mothers. You need to talk with your doctor about this.

Your Psychiatrist is a good option if you are planning a pregnancy. If you are under the care of an obstetrician, he/she can discuss with your psychiatrist to take the best decision for you. You can get help and support at the Psychiatry Departments of all medical college hospitals. In addition, many districts level hospitals have consultant Psychiatrists to help you.

“Maternity blues” or “baby blues” occurs in about half to two-third of women after giving birth to a child. It usually occurs within 3-4 days of delivery, lasts for a few days, then resolve on their own.

But some cases, about 10-15% of women develop more severe symptoms within 3 months of their delivery. About one-third of the cases begin during pregnancy, usually in the last trimester. This is when a diagnosis of Postnatal Depression (PND) is made.

• Irritability
• Low mood with frequent crying or tearfulness
• Guilty about not coping with the stress and unable to enjoy “motherhood”
• Excessive fears about the baby’s health
• Indifferent about the baby
• Changes in appetite
• Problems in sleeping
• Unable to enjoy anything, including sex
• Avoid social interactions
• Sometimes, thinking about harming the baby or herself

Recognizing the problem is the first step of prevention. Don’t just assume that it is okay to feel this way while coping with motherhood, or feel ashamed for not being able to enjoy it.

Find someone to talk to.Talk to your partner, a family member, or a friend. If you cannot confide to your partner, relative or have no close friend, take professional help from a psychotherapist or psychiatrist.

If you were on antidepressants before pregnancy or during pregnancy, do not stop medicationwithout the advice of your doctor. You are more likely to relapse, develop more severe problems, if medication is discontinued in pregnancy orbreastfeeding.

Do not hesitate to take help from family and friends. Taking care of a new born can be tiresome. You are not a “superwoman”.

• Healthy eating is an important part of your well-being.
• Adequate sleep and rest are essential for you and your baby.
• Try to Exercise regularly for 15minutes to 1 hour.
• Do find time to relax and enjoy yourself, listening to music, watching a movie, taking a walk.

When you develop the symptoms discussed, consult with a psychiatrist as soon as possible. Taking medication and psychotherapy will recover the problem in 2-6 months.

• National Institute of Mental Health and Hospital, Dhaka
• Department of Psychiatry, BSMMU, Dhaka
• Any nearby Government or Private Medical College & Hospitals with psychiatric departments.

As a partner you may feel guilty, angry and helpless. Understanding that it is a temporary condition and your partner needs support from you is important.

Discuss with the doctor what the condition is, the treatment, the possible risks and benefits of taking medication and psychotherapy.

Be empathetic towards the mother, talk to her about her feelings, help her in taking care of the child and ensure proper rest and diet.

Future Risks

Even after recovery, 30% of PND cases have some symptoms left and may need long term treatment and follow up.

Some may relapse again in the subsequent years following full recovery so look out for-

• Unusual mood changes, irritability, low mood
• Quiet and avoiding people
• Changes in eating and sleeping patterns

There is a chance of having the same problems in the future pregnancies, so consultation with a psychiatrist before planning pregnancy is a key factor to prevent it from happening again.

is a disorder of the mind that affects how you think, feel and behave.

Commonly, people use it to describe violence, public nudity and other socially inappropriate and unacceptable behaviors but that is only a small portion.

The National Mental Health Survey (2018-19) reported that about 1.0% of the adult population and 0.2% of children below 18 years are suffering from schizophrenia in Bangladesh.

Many symptoms occur in schizophrenia that are part of a broad range of “psychotic disorders” and the symptoms are not always violent.

Hallucinations
A hallucination happens when you hear, smell, feel or see something. The commonest one ishearing voices. They sound utterly real, present almost all the time and cannot be stopped when you want. They can be rude, abusive, demeaning or commanding. You may try to ignore them, talk back or even shout back at the voices. You may wonder where they are coming from… hidden microphones, speakers. But reality is these are imaginary voices, NOT REAL. They are generated in the mind.

Sometimes you may not hear but see things that others around you cannot see, or smell or taste things that others cannot. Sometimes you may feel something or someone is touching you, crawling under your skin but you cannot see them.

Delusions
Delusions might begin with a feeling that someone or something is trying to harm you, or control you.The idea transforms into a complete belief, you are sure of it but no one around you understands or believe it. It’s like you see the world, the people, the things in a completely different way that cannot be explained by your educational background, culture or religion.

Thought Disorder
You may feel you are losing your chain of thoughts and cannot find words. You find difficulty in concentrating, completing your tasks. Other people cannot understand what you are saying as your thoughts are disconnected.

Other Symptoms
You lose interest in life, energy, motivation to get any work done. You don’t bother to get up and tidy yourself, change clothes, take shower. You feel uncomfortable being around people, take no interest in interacting with them.

No. The symptoms vary from individual to individual.

There is no definite answer to what causes schizophrenia. It is probably a combination of several things, different in different people. Both men and women are almost equally affected, but more city persons have schizophrenia.Although 1 in 100 people get schizophrenia, about 1 in 10 of them have a parent with schizophrenia.Birth complications, street drugs can bring on schizophrenia. Amphetamine (yaba), cannabis (ganja, weed) produce schizophrenia like symptoms.Childhood trauma, difficulties in coping with life stresses, adverse family environment may trigger or worsen a schizophrenia patient.

Only some patients with schizophrenia become violent and require hospital admission. Many do not even go to hospital and settle down when symptoms are mild.

For every 5 people who are diagnosed with schizophrenia,

• 1 will remain socially active, lead a more or less active life within 5 years,
• 3 will have some improvement but will not be able to go back to absolute normal life, and there will be times when their symptoms worsen,
• 1 will have troublesome symptoms for very long period of time.

When schizophrenia is treated early,

• you are less likely to have to come into hospital,
• you are less likely to need intensive support at home,
• if you do come into hospital, you will spend less time there,
• you are more likely to be able to work and live independently.

• National Institute of Mental Health and Hospital, Dhaka
• Department of Psychiatry, BSMMU, Dhaka
• Any nearby Government or Private Medical College & Hospitalswith psychiatric departments.

How long will you take the medication?
It is suggested that medicines should be taken for at least 2 years, or longer. Depending upon your recovery, medications will be reduced gradually and you can notice if your symptoms are returning again. To sum up, the psychiatrist will decide how and when to reduce and stop medication.

WARNING SIGNS

• Suicidal thoughts, urges or even, attempts.
• Violent behavior where family, neighbors are at risk of being harmed.
• Refusal to take any food or medicines.
• High fever, hands and legs becoming stiff, unable to swallow food or water, unconscious or delirious.

Schizophrenia is certainly a chronic, debilitating condition. However, with taking medication as advised, psychological therapies and family support, you can live a life that maybe normal, or near normal.

Recognizing early signs

• You know your symptoms are returning when your daily activities go down.
• You feel anxious, not sleeping or eating well, not changing clothes.
• You feel suspicious or fearful and worry about other people’s motives.
• You find it difficult to concentrate.

Family therapy
This helps your family to cope better with the situation, discuss information about schizophrenia, what to do and how to solve practical problems and adjust their expectations.

Try to avoid

• Stressful situations.
• Using street drugs or alcohol.
• Make sure you regularly do something you enjoy.
• Eat healthy and stay physically active.

REMIND YOURSELF THE VOICES CANNOT HARM YOU.
REMIND YOURSELF THE VOICES HAVE NO CONTROL OR POWER OVER YOU.

When a person hurts or harms himself – on purpose. Self-harm is sometimes known as self-injury, where someone harms their body without wanting to die. Many people who harm themselves also have suicidal thoughts. This can be for any reason, in any situation and in a number of ways, such as:

• Taking too many tablets
• Cutting, burning, punching himself
• Misusing drugs
• Sticking things in the body, swallowing things that are dangerous.
• Deliberately starving himself

About 1 in 10 young people self-harm at some point, but it can happen at any age. About 1 in 3 people who self-harm will do it again during the following year. Over a 15-year period, 3 people in every 100 people who self-harm (3%) will die by suicide. Cutting is probably the more common way of self-harming, then overdosing.

• People who feel distressed and very sensitive to rejection.
• More women than men harm themselves.
• Who were sexually, emotionally or physically abused in their early life.
• Facing difficult life events including bullying, bereavement, relationship breakdown, poverty.
• Who have mental illnesses like personality disorders, depression, drug abuse problems.
• LGBT people.
• Prisoners, juveniles living in detention center.

People often don’t know why they harm themselves. But researchers have reported that some of the following reasons could be behind self-harm.

• To escape from feeling of emptiness, guilt, depression, shame, hopelessness, isolation.
• To stop feeling spaced out, unreal, sometimes called dissociation.
• To feel something – to know they exist, to feel in control, to forget something, to relieve tension, pressure, anger.
• To punish themselves.
• To cope with expectations of others.
• To let people know how bad things are, to get people listen to, to get sympathetic response from others, to make the body show the pain.
• To feel part of a group.
• As an alternative to killing themselves.

Ways to stop harming –

• Try to delay the act of self-harm. Go for a run, clean the house, go to the shops.
• Find some company. People self-harm when alone so go to a public place, be a good friend or safe family member, this may prevent harming.
• Distract yourself. Flick through a magazine, try cross-puzzles, an online or mobile phone game.
• Try the 10-minute delay tactic. Say to yourself that you will wait 10 minutes to self-harm. Try and keep busy during this time. When the time is up, think again. Can you wait another 10 minutes?
• Try relaxation and breathing exercises. Sit back comfortably in a chair or lie out on a bed. Relax all muscles in your body, beginning at the feet and working upwards. Concentrate on your breathing: breathe in for 5 seconds through your nose, hold your breath for 5 seconds, then breathe out slowly. Repeat this.
• Use other strong sensations to help distract you. Try loud music, a cold shower, a fast run, squeeze something very hard, smell strong perfume, eat hot chillies.
• Try to keep away from things you may use to harm yourself.
• The urge to harm yourself may come in waves, try to ‘surf the urge’, remember the strength of the urge will reduce in time, try to accept it and let it pass.
• Try to be clear about what you are feeling – is the emotion you are feeling: fear, shame or guilt, anxiety, anger, rage, sadness or depression? Try and observe, label and accept the emotion. Ask yourself why you are feeling it. Remember that you are not your emotion – you don’t have to act on it.

• Talk to the person when they feel like self-harming.
• Help them find out more about self-harm – you could show them our website or find self-help resources for them online.
• Help them to see self-harm as an ordinary problem that requires support and understanding.
• Don’t’ expect it to stop overnight – it takes time and effort.
• Don’t react strongly with anger, hurt or upset. This will probably make them feel even worse – and this makes it harder to change.
• Don’t force them to promise not to do it again.
• Don’t say that you won’t see them unless they stop self-harming.

It may be helpful for you to seek further supportif you can’t stop harming yourself and a psychiatrist may be the best person to talk to first. They may prescribesome medicines if you have depression, anxiety, etc. or may recommend psychotherapy for you or both. You can get help and support at the Psychiatry Departments of all medical college hospitals. In addition, many districts level hospitals have consultant psychiatrists to help you.